WOOHOO... I BEAT EM!!!!!
hahaha
after external appeal.... APPROVED!! DS is NOT an "Experimental" or " investigational" procedure.
anyone who tries to tell me otherwise will (again) get buried in 200+ pages of letters, medicare referrendums, insurance policy updates and medical journal articles
I just got off the phone with my insurance co... I've been calling them every day since last thurs... just to say "any word yet?"... seeing as my surgery is scheduled for TUESDAY 
I really needed to know soon. Called them up, got one of the people I usually get and said "Hi, it's your favorite customer of the month just checking in on my status". She must have my name and member # on a post-it on her screen... because she brought it up in no time.
started reading through the notes on the screen.... 10/13 material received, 10/18 denied, 10/25 further support material received (my appeal packet).... etc, etc.
then she said "ooh, wait a minute... here's something... right here 11/8, hey that's today...." she mumbles as she's reading through, then became clearer...(from memory, may not be exact) "meets requirements to be considered a valid procedure under current medical practices for this condition. there is sufficient data that is supported by peer-review, and it is accepted by the general medical community"
so it's official.... I have LESS THAN A WEEK before I become a loser 
make room on the bench... I'm comin in
I really needed to know soon. Called them up, got one of the people I usually get and said "Hi, it's your favorite customer of the month just checking in on my status". She must have my name and member # on a post-it on her screen... because she brought it up in no time.
started reading through the notes on the screen.... 10/13 material received, 10/18 denied, 10/25 further support material received (my appeal packet).... etc, etc.
then she said "ooh, wait a minute... here's something... right here 11/8, hey that's today...." she mumbles as she's reading through, then became clearer...(from memory, may not be exact) "meets requirements to be considered a valid procedure under current medical practices for this condition. there is sufficient data that is supported by peer-review, and it is accepted by the general medical community"
so it's official.... I have LESS THAN A WEEK before I become a loser
make room on the bench... I'm comin in 
(deactivated member)
on 11/8/06 6:41 am - syracuse, NY
on 11/8/06 6:41 am - syracuse, NY
That is so awesome ...congrats on you approval
OMG!!! Tenacious B, this is awesome . You have been so amazingly supportive to all of us on the board --> and you are so resourceful. I'm happy you are finally going to be a loser!!!! Keep us abreast of your progress, and I wish you a succesful DS surgery and a speedy recovery...
Ciao Bello (^_^) susie
. You have been so amazingly supportive to all of us on the board --> and you are so resourceful. I'm happy you are finally going to be a loser!!!! Keep us abreast of your progress, and I wish you a succesful DS surgery and a speedy recovery...
Ciao Bello (^_^) susie (deactivated member)
on 11/8/06 6:35 pm - MT
on 11/8/06 6:35 pm - MT
Sean,
YEAH... 
This is just great news hun and WOW your going to be a BIG LOSER soon... 
I am so happy for you hun.... 
Ok and there is only one other person that I dance for like that and that is Tavia....
Best of luck hun! 
Also I am so proud of you that you stuck it out and WON!!!!
Debra P
This is just great news hun and WOW your going to be a BIG LOSER soon...
I am so happy for you hun.... Ok and there is only one other person that I dance for like that and that is Tavia....
Best of luck hun!
Also I am so proud of you that you stuck it out and WON!!!!
Debra P Most Active
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